急性淋巴细胞白血病合并李斯特菌感染败血症1例报告并文献复习

目的：提高对急性白血病患者化疗中并发罕见细菌感染诊断及治疗的认识。方法：对1例急性淋巴细胞白血病患者化疗中发生李斯特菌感染败血症的临床资料进行分析,并进行相关文献复习。结果：该病例诊断为急性B前体淋巴细胞白血病,患者病程中合并反复产单核李斯特菌感染败血症,后引起弥散性血管内凝血、多器官功能衰竭,患者家属放弃治疗自动出院。结论：不明原因长期反复发热的患者应警惕罕见致病菌导致的感染;治疗不仅要以体外药敏试验为依据,同时也要提高患者自身免疫功能。     

合并维甲酸诱导分化治疗急性早幼粒细胞白血病(1例报告并文献复习)

急性早幼粒细胞白血病(APL)是常并发出血或弥漫性血管内凝血(DIC)的一类预后凶险的白血病,化疗的死亡率比其它类型的白血病高。目前,诱导早幼粒白血病细胞向正常分化被认为是治疗APL的新途径。     

儿童急性白血病并发弥漫性血管内凝血的早期护理

目的探讨儿童急性白血病并发弥漫性血管内凝血早期最佳的护理方法,提高病儿化疗过程中的耐受性。方法选择58例急性白血病并发弥漫性血管内凝血早期的病儿,进行化疗的同时,给予防治感染、出血及对症处理等一系列精心有效的护理。结果 58例病儿中除7例并发颅内出血、内脏出血放弃治疗、死亡外,余51例均成功完成诱导缓解治疗。结论儿童急性白血病并发弥漫性血管内凝血早期给予精心有效的护理干预,可以提高病儿化疗过程中的耐受性,帮助病儿成功完成诱导缓解治疗。     

维甲酸治疗急性白血病的护理

白血病是造血系统的～种恶性肿瘤．大多采用化学药物，中医中药，免疫和支持疗法等综合措施。而在综合治疗中，化疗又起主要作用。但是化疗，特别是较大剂量化疗后，病员的白细胞急剧下降．常可＜100／mm3．并伴有血小板明显减少。尤在急性早幼粒细胞性白血病患者化疗后，由于早幼粒细胞的大量破坏．可释放出含有促凝物质的颗粒，进入血流而发生弥漫性（血管内凝血（DIC），此时患者极易并发严重）感染与出血而造成死亡。近年来，用维甲酸（RA）治疗早助粒细胞性白血病．其最大的优点是不直接破坏白血病细胞，它的作用是促使细胞分化和成…     

急性白血病并发弥散性血管内凝血临床分析及治疗探讨

目的探讨急性白血病并发DIC的临床表现及其治疗措施。方法总结分析急性白血病并发DIC23例。全部病例在治疗原发病基础上进行抗感染、抗凝、运用肝素、补充血小板等治疗措施。结果急性白血病并发DIC临床以出血贫血发热溶血等表现,多发生在化疗早中期。治愈14例（6l％）,死亡9例（39％）。结论DIC是急性白血病严重并发症之一,治疗措施以稳妥治疗基础疾病的同时加强抗感染,高凝期肝素抗凝及低凝期补充血小板纤维蛋白等可收到较好效果。     

维甲酸联合小剂量肝素治疗并发播散性血管内凝血的急性早幼粒细胞白血病

急性早幼粒细胞白血病(APL)病程进展迅速而凶险．易并发播散性血管内凝血(DIC)，化疗疗效差，且能促发及加重DIC，患常在化疗过程中并发颅内出血死亡，成为血液病治疗中的一大难题。我们采用维甲酸(RA)联合小剂量肝素治疗并发DIC的APL17例，取得满意疗效，报告如下。     

对于急性白血病的临床治疗分析

目的：研究探讨急性白血病的临床特点和治疗方法。方法：回顾性分析急性白血病患者25例临床资料。结果：所有患者采用连续3周化疗法治疗急性白血病，其中急性淋巴细胞白血病12例采用COMP方案为主的3周疗法，急性非淋巴细胞白血病13例采用HOAP方案为主的3周疗法。急性白血病治疗总显效率74％、急性非淋巴细胞白血病总显效率76％。结论：连续3周化疗方法是治疗急性白血病的有效的方法之一，临床医生还需加强化疗期间的支持对症及感染控制，采用个体化治疗方案，把急性白血病的死亡率降到最低。     

急性白血病96例并发医院感染临床分析

目的：探讨急性白血病患者医院感染的危险因素及治疗。方法：回顾性调查分析急性白血病96例病历资料。结果：急性白血病医院感染率达48例（50．0％），在初诊白血病处于诱导缓解阶段及发生粒缺时医院感染率明显升高，感染部位以呼吸道、消化道为主。结论：在白血病治疗过程中处于诱导缓解阶段及并发粒缺是医院感染的主要危险因素，及时采取有效的抗生素及提高功能完善的粒细胞数是防治急性白血病医院感染的关键。     

儿童急性淋巴细胞白血病化疗后的不良反应

目的 分析儿童急性淋巴细胞白血病化疗后不良反应发生的特点及规律, 实施个体化给药避免或减少严重的药品不良反应 (ADR) 的发生.方法 收集2014年3月至2015年2月新发儿童急性淋巴细胞白血病化疗后不良反应184 3例, 对患者性别, 年龄, 危险度、药物、ADR累及器官或系统等方面进行研究分析.结果儿童急性淋巴细胞白血病化疗后不良反应涉及高危组患者居多;涉及药物以左旋门冬酰胺酶、长春新碱、阿糖胞苷居前3位;不良反应累及的系统或器官以血液系统最为常见;骨髓抑制并发感染与危险度及患儿年龄差异有统计学意义 (P<0.01) , 与性别无统计学差异 (P>0.05) .结论 儿童急性淋巴细胞白血病化疗后ADR以骨髓抑制最为常见, 其中以骨髓抑制及并发感染对患儿生活质量及治疗效果的影响最大.     

急性白血病患者化疗的护理体会

急性白血病主要治疗方法 为化疗,本文阐述了急性白血病患者进行化疗时的护理体会:局部血管反应及护理;消化道反应的护理;骨髓抑制的护理;鞘内注射化疗药物的护理;化疗药物对心脏、肝脏、神经系统损害的防护以及预防尿酸性肾病的护理.     

葛根素致急性血管内溶血5例临床分析

目的:总结葛根素致急性血管内溶血的临床病例特点,为临床今后预防和诊断治疗提供帮助.方法:对临床所见5例静脉应用葛根素治疗中发生急性溶血的病例进行临床分析.结果:所有病例均有反复用药史,发生急性溶血前有前驱先兆症状;急性血管内溶血的特点是在静脉应用葛根素中,突然发生腰腹疼痛、寒战、发热、呼吸困难、一过性意识丧失、尿色加深或血尿、血色素下降、网织红细胞升高、直接抗人球蛋白试验阳性.结论:临床凡遇到应用葛根素突然出现上述临床症状者,就应考虑急性血管内溶血发生,应立即停药,给予积极治疗.     

Infectious complications in four long-term recipients of the Jarvik-7 artificial heart

This article describes the infectious complications that occurred among four of the longest-term recipients of the Jarvik-7 artificial heart. Infection arising from the drive lines, with spread to the mediastinal periprosthetic space, was the major limiting factor in long-term use of the device in these patients. Periprosthetic infections were due to coagulase-negative staphylococci, Staphylococcus aureus, Pseudomonas aeruginosa, and other Pseudomonas species. Other infectious complications incurred by some of the patients included pneumonia, empyema, urinary tract infection, and intravascular line sepsis with Candida. Intensive antimicrobial therapy for prolonged periods seemed to suppress but not to eradicate infection and was accompanied by the appearance of multiresistant bacterial strains. Complications of antimicrobial therapy included diarrhea secondary to overgrowth with Clostridium difficile in two patients. Use of the current device for more than 30 days should be considered extraordinary and should be reserved for patients for whom no other form of life support is available.     

单用替代疗法治疗急性白血病合并DIC的疗效

目的:回顾性观察急性白血病合并弥漫性血管内凝血(DIC)时采用替代疗法加用与不加用肝素的疗效对比。方法:66例急性白血病合并DIC患者均给予替代治疗(输注血浆和血小板),31例(A组)不给予肝素,对照组35例(B组)给予肝素5mg,q8h,不负载。如为急性早幼粒细胞白血病(M3)则同时使用全反式维甲酸或三氧化二砷。结果:DIC在A组和B组的治疗成功率分别为51.6%和54.3%.其差别无显著性,P>0.05。结论:急性自血病合并弥漫性血管内凝血(DIC)时采用替代疗法加用与不加用肝素可能同样有效。     

HIGH REMISSIONINDUCTION (TRADITIONALSINO-WESTERNHOAP) REGIMEN FOR ACUTE NONLYMPHOCYTIC LEUKEMIA Hematology Research Division and Hemtatology Section of the Children's Hospital, Suzhou Medical, College, Suzhou

23 adults and 5 children with acute nonlym- phocytic leukemia (ANLL) were given a tradi- tional Sino-Western HOAP regimen for remis- sion induction. The complete remission* (CR) rate for the group was 82.1%, being higher for acute granulocytic leukemia, acute promyelocy- tic leukemia and erythroleukemia and somewhat lower for acute myelomonocytic and acute mo- nocytic leukemia.. During the induction regimen, supportive therapy with traditional Chinese me- dicine, blood transfusions, antibiotics and levi- masole were important.     

C反应蛋白和D-二聚体对急性白血病伴感染患者的临床检查价值

目的 探讨C反应蛋白和D-二聚体对急性白血病伴感染患者的临床检查价值。方法选取该院血液科2011年1月—2013年12月诊断为急性白血病的住院病人,诊断为有感染的患者定义为感染组40例;诊断为弥漫性血管内凝血的患者为弥漫性血管内凝血组40例;同时有感染与弥漫性血管内凝血的患者归为感染＋弥漫性血管内凝血组40例。测取各组C反应蛋白和D-二聚体数值。结果感染组、弥漫性血管内凝血组及感染＋弥漫性血管内凝血组C反应蛋白和D-二聚体分别为[（42.8±10.5）mg/L、（0.8±0.3）μg/L;（16.5±5.8）mg/L、（1.5±0.6）μg/L;（88.7±21.7）mg/L、（6.8±1.7）μg/L],C反应蛋白和D-二聚体以联合组最高,弥漫性血管内凝血组最低,三组的差异有统计学意义（P〈0.05）;以C反应蛋白[（〈10 mg/L）、（10≤,〈100 mg/L）、（≥100 mg/L）]进行分层,CRP≥100 mg/L的人群中,发生DIC比例及血中D-二聚体值最高,而C反应蛋白〈10 mg/L的人群中,发生DIC比例及血中D-二聚体值最低,差异有统计学意义（P〈0.05）。结论该研究认为急性白血病病人普遍存在感染和异常凝血,可以C反应蛋白和D-二聚体作为检测指标,判断患者是否有发生弥漫性血管内凝血与感染的风险。     

2000～2010年20例血液病合并结核感染临床分析

目的探讨良、恶性血液病合并结核感染的临床特征及诊断治疗方法。方法对2000～2010年间我院收治的良、恶性血液病合并结核感染患者20例的临床特征和诊治方法总结分析。结果 20例患者均给予正规抗结核(四联)及标准方案抗原发病治疗,抗结核治疗均有效;其中3例3个月后肝脾淋巴结均明显缩小、消失;仅其中1例急性白血病,拒绝行化疗,半年后因合并肺真菌感染及真菌败血症致结核致病灶扩散而死亡。结论恶性血液病合并肺结核感染后的临床表现不典型,对于恶性血液病患者在抗肿瘤治疗有效时出现不明原因的发热,经抗感染、抗真菌治疗无效时,应高度警惕合并结核感染的可能。     

Severe hemolytic anemia and acute psychosis caused by Clostridium perfringens sepsis

BACKGROUND: Clostridium perfringens septicaemia with massive hemolysis is well known. The infection induced acute hemolytic attack frequently occur in chronic corpuscular hemolytic anemias. Alterations in mental status are common in septic patients. CASE REPORT: The case of a 39-year-old woman with a history of chronic corpuscular hemolytic anemia, experiencing weakness, pallor, somnolence is presented. Hypothermia and an acute paranoid psychotic episode subsequently developed in the hospital. C. perfringens sepsis was detected from blood cultures. The patient was cured by penicillin and clindamycin. Her symptoms disappeared and there was total resolution of toxic encephalopathy according to the brain MRI after 6 weeks. CONCLUSION: This report discusses the possible explanation of clostridial sepsis the role of brain MRI in the sepsis-induced organic psychosyndromes and underlines the need for obtain blood cultures in hypothermia suggestive to sepsis.     

小剂量肝素治疗急性白血病前DIC 46例临床分析

目的探讨小剂量肝素治疗急性白血病前弥漫性血管内凝血(pre-DIC)的疗效及其安全性。方法急性白血病前DIC46例,随机分成2组,小剂量治疗组23例(A组),常规治疗组23例(B组),比较两组疗效。结果A组转化为DIC的患者少于B组(P<0.05)。D-二聚体转阴A组高于B组(P<0.05)。结论小剂量肝素治疗急性白血病Pre-DIC能有效阻止其向DIC发展,且具有良好安全性。     

Effect of antimicrobial agents on the toll-like receptors and inflammatory cytokines in liver tissue of the alcohol-induced liver disease in rats with Vibrio vulnificus sepsis

Background Septicemia and inflammation-mediated septic shock caused by Vibrio vulnificus （VV） is strongly associated with chronic liver disease. This study examined the effects of antimicrobial therapy on expression of hepatic toll-like receptors and inflammatory cytokines in rats with alcohol-induced liver disease complicated by VV sepsis. Methods Male Sprague-Dawley rats were assigned to the following treatment groups： normal control （N）, alcoholic liver disease control （A）, antimicrobial-treated alcoholic liver disease control （AA）, alcoholic liver disease with VV sepsis （AV）, and antimicrobial-treated alcoholic liver disease with VV sepsis （AVA）. Alcohol-induced liver disease was observed in all groups except N. Expression of mRNAs encoding hepatic toll-like receptors 2 and 4, myeloid differentiation protein-2, tumor necrosis factor-α （TNF-α）, interleukin （IL）-1β, IL-6 and IL-10 was determined by RT-PCR. Results mRNAs encoding toll-like receptors 2 and 4 and myeloid differentiation protein-2 were significantly up-regulated in group AV as compared to control groups at 2-24 hours of sepsis; peak expression occurred at 12 hours. These mRNAs were also up-regulated in group AVA but to lesser degrees than in group AV at comparable time post-infection, mRNAs encoding TNF-α, IL-1β and IL-6 were significantly elevated in group AV as a function of infection. In group AVA as compared to AV, expression of TNF-α and IL-1β mRNAs was lower at 12-24 hours post-infection and expression of IL-6 mRNA was lower at 24 hours post-infection. Compared with control groups, IL-10 mRNA expression in group AV was markedly higher at 12-24 hours of sepsis. Expression of IL-10 mRNA was lower in group AVA as compared to AV at 24 hours of sepsis. Conclusions Antimicrobial therapy reduces expression of toll-like receptors and cytokines in rats with alcohol-induced liver disease complicated by VV sepsis. Monitoring hepatic toll-like receptor and cytokine expression during antibiotic therapy may be valuable for determining the course of VV sepsis in subjects with liver disease.     

Disseminated intravascular coagulation in acute monoblastic leukemia: response to heparin therapy

A 27-year-old man with acute monoblastic leukemia had clinical and laboratory evidence of disseminated intravascular coagulation (DIC), which was exacerbated by induction chemotherapy. Heparin therapy, adjusted according to the patient's clinical status and the results of coagulation studies, rapidly controlled the manifestations of DIC.